Jalili Mohammad, Barzegari Hasan, Pourtabatabaei Nasimi, Honarmand Amir Reza, Boreiri Majid, Mehrvarz Amir, Ahmadinejad Zahra
Department of Emergency Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2013 Aug 7;51(7):454-60.
Sepsis constitutes an important cause of hospital admission with a high mortality rate. Appropriate antibiotic therapy is the cornerstone of therapy in patients with sepsis. Although numerous studies have recommended early antibiotic initiation in severe sepsis or septic shock stages of sepsis syndrome, its role in treatment of patients with sepsis who have not entered these stages remains to be investigated. The purpose of this study is to investigate the effect of door-to-antibiotic time in sepsis patients with various degrees of severity. This is a longitudinal prospective cohort study on adult patients admitted with sepsis to the emergency department. Sepsis was defined as presence of at least two criteria of systemic inflammatory response syndrome and procalcitonin levels ≥ 2μg/l. Severity of sepsis was determined using the APACHE II (Acute Physiology and Chronic Health Evaluation II) scoring system. Time to antibiotic administration was recorded and its relationship with mortality was assessed. A total of 145 patients were eligible for enrollment. The mean age was 60.4 years and the mean APACHE score was 13.7. The overall in-hospital mortality was 21.4%, and the mean length of stay in hospital was 211.9 hours. The mean door-to-antibiotic time for our patients was 104.4 minutes. Antibiotic administration time and mortality in patients with APACHE scores of 21 or higher (P=0.05) were significantly related; whereas such a relationship was not observed for patients with APACHE scores of 11- 20 (P=0.46). We observed early antibiotic initiation for patients in sepsis phase with higher severity scores was associated with significant improvement in survival rate.
脓毒症是导致患者住院的重要原因，死亡率很高。恰当的抗生素治疗是脓毒症患者治疗的基石。尽管众多研究推荐在脓毒症综合征的严重脓毒症或脓毒性休克阶段尽早开始使用抗生素，但其在尚未进入这些阶段的脓毒症患者治疗中的作用仍有待研究。本研究的目的是调查不同严重程度的脓毒症患者从就诊到使用抗生素的时间所产生的影响。这是一项针对入住急诊科的成年脓毒症患者的纵向前瞻性队列研究。脓毒症的定义为至少符合两条全身炎症反应综合征标准且降钙素原水平≥2μg/l。使用急性生理与慢性健康状况评分系统II（APACHE II）来确定脓毒症的严重程度。记录使用抗生素的时间，并评估其与死亡率的关系。共有145名患者符合纳入标准。平均年龄为60.4岁，平均APACHE评分为13.7。总体住院死亡率为21.4%，平均住院时长为211.9小时。我们患者的平均就诊到使用抗生素时间为104.4分钟。APACHE评分为21分或更高的患者，抗生素使用时间与死亡率显著相关（P = 0.05）；而APACHE评分为11 - 20分的患者未观察到这种相关性（P = 0.46）。我们观察到，脓毒症严重程度评分较高阶段的患者尽早开始使用抗生素与生存率的显著提高相关。
